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Gemistocytic astrocytomas: a reappraisal
H G Krouwer1, R L Davis, P Silver
1Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Journal of Neurosurgery
|March 1, 1991
Summary
Gemistocytic astrocytomas, often aggressive, show poor prognosis with ≥20% gemistocytes. Younger patients (<50) and those with longer pre-operative symptoms or seizures had better survival in this rare tumor study.
Area of Science:
- Neuro-oncology
- Neurosurgery
- Pathology
Background:
- Gemistocytic astrocytomas are rare glial tumors.
- Despite classification as slow-growing, they often exhibit aggressive behavior.
- Understanding their biological and clinical behavior is crucial for effective treatment.
Purpose of the Study:
- To clarify the biological and clinical behavior of gemistocytic astrocytomas.
- To identify prognostic factors influencing survival in these patients.
- To evaluate the significance of gemistocyte percentage in glial neoplasms.
Main Methods:
- Retrospective analysis of 51 patients with gemistocytic astrocytoma diagnosed between 1976 and 1989.
- Histological review using two criteria: 'pure' (≥60% gemistocytes) and 'mixed' (20-60% gemistocytes).
- Evaluation of patient demographics, treatment modalities (surgery, radiation, chemotherapy), and survival outcomes.
Main Results:
- No significant difference in median survival between 'pure' (136.5 weeks) and 'mixed' (135.6 weeks) groups.
- Younger age (<50 years), longer preoperative symptoms (>6 months), and seizures as initial symptom correlated with better prognosis.
- Gross total resection was associated with survival, while biopsy alone resulted in mortality.
Conclusions:
- The presence of at least 20% gemistocytes in a glial neoplasm is a poor prognostic indicator.
- Gemistocytic astrocytomas should be classified with anaplastic astrocytomas and treated accordingly.
- Age, symptom duration, and initial seizure presentation are important prognostic factors.